The Wayfinding Questionnaire as a Self-report Screening Instrument for Navigation-related Complaints After Stroke: Internal Validity in Healthy Respondents and Chronic Mild Stroke Patients

Abstract

Objective: In current stroke care, cognitive problems are usually diagnosed in a stepwise manner. More specifically, screening instruments are first applied to support healthcare professionals in deciding whether a second step (an extensive assessment) would be appropriate. None of the existing screening instruments, however, takes navigation ability into account. This is problematic, as navigation impairment after stroke has been shown to be common, more so than previously thought. The Wayfinding Questionnaire (WQ) is therefore presented as a screening instrument for navigation-related complaints after stroke. The internal validity of the WQ was investigated in two samples of participants to establish the final version. Method and Results: In Study 1, the WQ was administered in a representative sample of 356 healthy participants. Its factor structure was investigated using a principal component analysis. This procedure resulted in deletion of four items and revealed a three-factor structure: "Navigation and Orientation," "Spatial Anxiety," and "Distance Estimation". In Study 2, a confirmatory analysis was performed to directly verify the factor structure as obtained in Study 1 based on data of 158 chronic mild stroke patients. Fit indices of the confirmatory analysis indicated acceptable model fit. The reliability of the three subscales was found to be very good in both healthy participants and patients. Conclusions: These studies allowed us to determine the final version of the WQ. The results indicated that the WQ is an internally valid and reliable instrument that can be interpreted using a three-factor structure in both healthy respondents and chronic mild stroke patients.

The Wayfinding Questionnaire: A clinically useful self-report instrument to identify navigation complaints in stroke patients

“…Our study ensues from previous research on the validation of the Wayfinding Questionnaire (WQ) as a clinically useful instrument to identify complaints about navigation ability in stroke patients (Claessen, Visser-Meily, de Rooij, et al, 2016b). The hypothesised associations that we regard as being clinically relevant were sufficiently confirmed.…”

“…The study procedures were approved by the medical ethical review board of the University Medical Centre Utrecht (protocol number 12-198). The recruitment procedures have been described in detail elsewhere (Claessen, Visser-Meily, de Rooij, et al, 2016b). Briefly, 158 stroke patients were included who visited the rehabilitation centre or hospital rehabilitation department in Utrecht, the Netherlands.…”

“…A subset of the stroke patients (n = 78) were assessed for navigation ability in a virtual reality setting using the Virtual Tübingen test (Claessen, Visser-Meily, de Rooij, et al, 2016b;Claessen, Visser-Meily, Jagersma, Braspenning, & van der Ham, 2016;van Veen, Distler, Braun, & Bülthoff, 1998). The patients were twice shown a video of a virtual route through a photorealistic rendition of the German city Tübingen on a laptop screen (17.3-inch diagonal HD4 display).…”

“…The WQ was recently tested for internal validity in a large group of healthy controls and mild stroke patients. This study resulted in a final version of the WQ containing 22 items and taking less than 10 minutes to complete (Claessen, Visser-Meily, de Rooij, Postma, & van der Ham, 2016b). However, additional evidence to support its clinical usefulness in stroke patients is required for use in clinical practice.…”

Large-scale assessment of human navigation ability across the lifespan

“…Also, education level was added as a question for adults, with all the levels available in the Dutch school system as response options, which were later recoded to the description of Verhage 38 , resulting in scores ranging from 1 (lowest) to 7 (highest). Spatial anxiety was assessed by using one of the items of the Wayfinding Questionnaire, most predictive of the spatial anxiety subscale 39,40 ; 'I am afraid to get lost in a city I do not know' , with response options 1 (totally disagree) to 7 (totally agree).…”